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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 25 (2014), Issue 5, Pages 277-280
Original Article

Correlates of Illness Severity in Infectious Mononucleosis

John Odame,1 Joan Robinson,2 Nasser Khodai-Booran,1 Simon Yeung,1 Tony Mazzulli,3 Derek Stephens,4 and Upton D Allen1,4

1Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
2Division of Infectious Diseases, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
3Mount Sinai Hospital, University of Toronto, Canada
4The Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


INTRODUCTION: Understanding the spectrum and frequencies of Epstein-Barr virus (EBV) complications and markers of illness severity in immunocompetent patients with primary EBV infection will inform management of patients with EBV-related illnesses.

OBJECTIVES:To determine the clinical and laboratory correlates of illness severity among infants, children and youth with infectious mononucleosis (IM).

METHODS: Study subjects with confirmed IM were prospectively enrolled. Illness severity was assessed at baseline and at six weeks using a scoring tool. Peripheral blood viral loads served as a measure of viral burden.

RESULTS: Among 32 children and young adults with IM, the median age was 16 years (range two to 24 years). The predominant clinical findings were lymphadenopathy (23 of 32 [72%]), pharyngitis (16 of 32 [50%]), fever (nine of 32 [28%]) and splenomegaly (six of 32 [19%]). With respect to symptoms or signs that persisted to at least six weeks after illness onset, the predominant complaint was lymphadenopathy in 35% of subjects available for reassessment. Deranged liver function tests were present at presentation in up to 44% of subjects. Patients with the highest viral loads at presentation had significantly higher illness severity scores associated with fatigue (P=0.02). Other than the scores associated with fatigue, viral load values were not significantly correlated with the illness severity scores at baseline and at six weeks.

CONCLUSION: In IM, viral loads are not necessarily correlated with illness severity, with the exception of fatigue. EBV-related hepatitis is common in IM, confirming the status of this virus as a relatively common cause of transient hepatitis in children and youth. This entity is not necessarily a marker of disease severity.